‘Ethics consultation’ is the term most often used to refer to the response to a request for assistance with moral issues or questions that arise in the care of a particular patient. In recent years, ethics consultation has become one of the most important activities in the area of clinical ethics. Widely discussed in the medical literature, it was also the subject of a major 1998 report, “Core Competencies for Health Care Ethics Consultation,” written by a joint task force of the Society for Health and Human Values and the Society for Bioethics Consultation and later adopted by the American Society for Bioethics and Humanities. Currently, professionals in several different disciplines provide ethics consultation, using a variety of formats and techniques.

At Pitt County Memorial Hospital (PCMH), the Medical Ethics Committee has offered ethics consultation for a number of years. Using a procedure developed by the Medical Ethics Committee in 1995, patients, family members, and anyone providing care for a patient may request assistance with an ethics issue at any time by contacting a hospital chaplain or patient representative. The chaplain or patient representative relays the request to an Ethics Committee representative, and that representative helps to arrange a meeting of the interested parties with members of an ethics consultation subcommittee. At that meeting, a caregiver presents the case and those present discuss the questions it poses, examine alternative courses of action, and, if appropriate, offer suggestions about how to proceed.

Evaluations completed by participants in case consultation meetings indicate that the meetings are generally useful in examining the issues and reaching agreement on a reasonable course of action. In the year 2000, however, Medical Ethics Committee members expressed concern that the number of requests for assistance with an ethics question had decreased considerably. Late that year, the Committee appointed a small ad hoc task force to evaluate its case consultation service and suggest possible improvements.

To guide its efforts, the task force gathered several types of information. It solicited and received copies of the ethics consultation policies and procedures of other regional teaching hospitals. Several of these use a consultation subcommittee model similar to that of PCMH; others use a two-person team or individual consultant model. The task force also developed and disseminated a brief survey to a sample of some 300 attending physicians, residents, nurses, and other health professionals working in the hospital. This survey was designed to gauge the respondents’ knowledge and experience with ethics consultation and reasons why they had not requested an ethics consultation. Although most of the respondents were aware of this service, less than one quarter had requested or participated in a case consultation meeting. Respondents noted a number of reasons for not requesting ethics consultation, including not needing assistance with an ethics question and getting help in other ways. Some physicians responded that the process would be too time-consuming; some non-physician respondents noted that they would not feel free to request a consultation. In written comments, several respondents commented that the service needed to be publicized more effectively.

The ad hoc task force reviewed this information with the full Medical Ethics Committee and recommended a revision of the consultation procedure to the Committee. The task force proposed that the Committee offer a new option, in addition to the existing consultation subcommittee meeting option. Under the new option, persons can request a consultation from a two-person team, consisting of a physician and an ethicist member of the Committee. The consult team will meet with the interested parties, including the patient, patient’s family, physicians, and nurses, and may seek the advice of other professionals. The consultants then communicate their suggestions to the interested parties, and usually enter a written summary of the consultation in the patient’s record. Task force members argued that the two-person team option might be attractive to some of those seeking ethics assistance, since it may be more flexible and less intimidating than a consultation subcommittee meeting. The Medical Ethics Committee approved the new consultation option, and team consultations began early in 2002. The first seven months of 2002 have brought requests for four “team” consultations and the same number of subcommittee consultations. Preliminary review of evaluations suggests that both models have effectively addressed the moral issues raised by those seeking assistance.

The Medical Ethics Committee has taken several other steps in recent months to improve access to ethics consultation. Committee members have developed and begun to offer brief in-service presentations explaining the consultation process to staff in their individual hospital units. The Committee has also prepared and disseminated a new brochure describing the ethics consultation service in clear and simple language. Medical Ethics Committee members are hopeful that these efforts will increase requests for ethics consultation at the hospital; only time will tell.